This OP is a review of George Simon Jr.’s Character Disturbance: The Phenomenon of Our Age (Little Rock: Parkhurst Brothers, 2011).

Simon’s thesis

Simon wants to warn lay readers about, and advise therapists on how to treat, what he calls “character disturbance.” In its more severe stages, character disturbance leads to “character disorders,” among which we can see varying degrees of personality styles that in their more extreme form might include what we know as pathological narcissism, “borderline” behavior, and sociopathy and psychopathy. We can identify character disturbances by choices people make, unfettered or insufficiently fettered, by the feelings of guilt and shame that afflict the rest of us.

Simon contrasts disturbed characters with “neurotics.” These are susceptible to “the conflict that rages between primal urges and qualms of conscience.” (That quotation comes from a blog post Simon has written. But he says basically the same thing, if less quotably, on page 13 of his book.) The average layperson and most therapists too often treat disturbed characters as neurotics acting from neurosis-like motivations. It’s more useful, however, to consider that disturbed characters simply do what they do to get what they want as soon as they can and with the least amount of work possible. We should hold them responsible for their actions, and therapists should use Cognitive Behavioral Therapy (with a focus on the “behavioral”) to give them the tools to change.

Character disturbance is the “phenomenon of our age” because our present-day society and culture encourage people to value their self-esteem over their self-respect. People with character disturbance already have a high self-esteem. They just don’t have the self-respect necessary to feel shame at what their actions show them to be.

The myth of our disturbed age

The book’s subtitle (“the phenomenon of our age”), preface, epilogue, and incidental remarks throughout all point to two questionable assumptions. The first is that character disturbance and character disorders are on the rise. The second is that the manner in which our current culture promotes and condones those ways of acting is unprecedented or somehow unique. Both assumptions imply that our current “near epidemic” [p. 14] is new and dangerous and threatens to undermine “the very foundations of our free society.” [p. 19].

I defer in part and dissent in part. I defer to Simon’s claims about his profession (he’s a former therapist, now writer). He says that therapists in the US are generally trained in the “classical” model of neurosis, with nary a regard for treating character disturbance as a thing in itself. This classical model does a poor job of treating individuals with character disturbance so that in recent decades, therapists whose clients have character disturbances do not treat them effectively. If Simon is wrong on these points, that’s something someone with more knowledge than I about the mental health professions and clinical practice can pursue.

I dissent, though, that we can know with Simon’s confidence that character disturbance is more prevalent now than before and that “self-esteem culture” is somehow unique in the way it encourages character disturbance. Maybe self-esteem culture from ca. 1970 onward condones and encourages character disturbance, but other cultural trends from different eras could plausibly have done the same. I offer as one example white supremacy and the “lynch law” it inspired in the era of Jim Crow. You can probably think of other examples.

I dissent also because it probably doesn’t matter. Whether character disturbance is more prevalent, less prevalent, or about as prevalent as before, it is still a problem that needs to be addressed. If it is indeed a “near epidemic,” then I guess we need to take more assertive measures, rethink our notions of crime and punishment, or go beyond the “political correctness…and the tendency to put personal beliefs and interests ahead of the general welfare”–all of which “impair our ability to conduct an honest discourse and debate.” (p. 252).

But any “honest discourse” has to consider the limitations of what we know. One of Simon’s key points of evidence–our rising prison population–could have other causes in addition to increased incidence of character disturbance. One might argue that the rising prison population represents society taking a firmer stand against character disturbance and disturbed characters are now facing their comeuppance. I don’t endorse that argument, but it’s consistent with Simon’s evidence and yet also runs against the point he wishes to draw from that evidence.

Continuums and sharp distinctions

Simon posits a “continuum” between neurosis and character disturbance [p. 29]. Someone is neurotic to the extent that they don’t have a character disturbance. Someone has a character disturbance to the extent that they are not neurotic.

Simon also notes the promise of a third way out of the continuum and toward what he calls “self-actualization altruism.” Those who approach this altruism “freely and completely commit themselves to advancing the greater good. They are not neurotic because they have no driving desire to avoid guilt or shame for doing otherwise. Also, they’re not out for personal glory or to be revered by society.” [p. 29, italics in original] He doesn’t dwell on that point. In fact, he’s skeptical that there is a third way out and suggests that for practical purposes his continuum makes more sense.

But even so, I’d like to see more discussion about the continuum than Simon offers. Too quickly he jumps from discussing the continuum to distinguishing between neurotics and people with character disturbance. He does not discuss the positions on the continuum where many (most?) of us likely fall. Maybe the turn toward “self-actualization altruism” happens never or only rarely. But is there then, as an alternative, an optimal place on the continuum for us to be?

Such a discussion is probably beyond the scope of the book. Perhaps Simon needs to draw sharp distinctions because 1) his audience includes laypersons like me as well as experts like him; 2) his goal is to warn us about character disturbances and advise us on how to deal with them; and 3) you can cover only so much in any book and still have it be readable.

So…you know it when you see it?

Let’s grant that for sake of readability Simon must make sharp distinctions between the character-disturbed and the rest of us, but how do we know who the character-disturbed or character-disordered are? He gives some clues, especially in Chapter 6, “Habitual Behavior Patterns Fostering and Perpetuating Character Disturbance.” Most of these patterns boil down to denying or deflecting responsibility for harmful actions.

But in a broader sense, how do we know, especially in the “edge” cases where someone is character “disturbed” but not badly enough to be character “disordered”? How do we–especially the laypersons who seem to be part of Simon’s target audience–discern whether someone is character disturbed as opposed to being neurotically disturbed?

Maybe if someone acts like a character disturbed person, we should treat them as such for our own self-protection and let the mental health professionals sort out the underlying causes. It’s probably on balance good to learn how to call out responsibility deflection whether or not the deflector is a disturbed character or merely an anguished neurotic. In some cases, it’s probably better to simply disengage regardless of where the deflector falls on the continuum.

Maybe we shouldn’t seek to “know.” Maybe judgment is for the Lord, and discernment is for a competent and licensed mental health professional. But that doesn’t sit well with me, either. One purpose of Simon’s work is to warn laypersons like me about these people. And while provisionally speaking I can learn a lot about how to respond to responsibility avoidance, part of how I respond depends on my general assessment of their character. If someone resorts to the trick of changing the subject when I bring up a problem it matters a lot to me whether that’s a one-off or part of a pattern of behavior.

Maybe the trick, then, is to find patterns. But there are patterns and then patterns on the patterns. Maybe I’ve just been lucky, but even the people I’ve known who I consider “character disordered” sometimes defy their own patterns.

The problem of suffering and compassion

My concern about knowing or discerning plays into another concern. If we actually have–and can say with confidence we have–an according to Hoyle disordered person before us, what role ought our compassion toward that person play?

Simon seems to say that the first compassionate thing to do would be to empower and help the victims. The second compassionate thing would be to help disturbed/disordered characters learn how to act differently. Cognitive Behavioral Therapy (with an emphasis on the “Behavioral”) can help–provided the disturbed/disordered character accepts responsibility for his or her actions and actually is willing to do what is necessary to change.

What about before the magic moment(s) when the disturbed/disordered person realizes they need to change? I think Simon would say the best we can do is call them on their tactics and make them take responsibility for what they do. In those cases, “compassion” is beside the point.

But I’m left to wonder, do disturbed/disordered characters “suffer”? Simon seems to say no, at least not as “neurotics” do. Or if disturbed characters do suffer, it’s only to the degree that they’re also neurotic (remember the continuum above). Disturbed/disordered characters are basically out to get what they want. Simon might concede that getting everything one wishes betokens a deeper and underlying, unhappiness or suffering. But I think he would suggest that we should focus on the behaviors and bracket the other types of questions as not useful.

Parting thoughts

Neurotics come off pretty good in Simon’s book. To the extent that he’s targeting a lay audience, he’s primarily targeting neurotics–and perhaps also the “self-actualizing altruists”– and not the disturbed characters qua disturbed characters. Neurotics make bad choices. But the key to helping them is work through the underlying issues, whatever those may be, in addition to introducing them to better coping behaviors.

Disturbed characters are different from you and me, especially if their disturbance is extreme enough to mark them as “disordered.” There’s hope for them, to be sure. At one point (I can’t find the page number), he suggests that even those we’d call seriously psychopathic might ultimately attain something like redemption or rehabilitation. But he seems to want our takeaway to be that they are the bad guys (and gals). And we, who presumably fall somewhere on the “optimal” range of the “neurotic”/”disordered” continuum, are the good people just trying to survive. That bothers me, even if he’s right. Especially if he’s right.

There’s something missing. Periodically, Simon hints that he too was once been a disturbed character, too. He refers (without specific examples) to other times of his life before he saw the light and started to change his behavior. He doesn’t go into detail. And he probably shouldn’t because that’s not the book he’s to be writing. However, if he ever chooses to write that book, I’ll be sure to read it.

About the Author

Gabriel Conroy (conroy, fka Pierre Corneille and corneille1640) is an ex-graduate student. Now he writes blogs! He has a solo blog--Ye Olde Republicke. The views expressed by Gabriel (or Pierre, or corneille1640) are his alone and do not necessarily reflect those of his spouse, employer, or his co-bloggers at Hitcoffee.

I wonder what Simon would say to that. He might say that he’s not trying to do moral philosophy but just “telling it like it is.” I do believe, however, that there’s definitely a moral (or moralistic?) component to what he’s doing.

I haven’t read the book, so I don’t know how Simon draws his conclusions about the approach of the average psychotherapist, but I’m quite sure I don’t know even one clinician who isn’t well-acquainted with the differences between drive-conflict models and deficit models of psychopathology (disorder, dysfunction or whatever you prefer), along with implications for treatment of so-called neurotic conditions versus character disorders. Over the past 4 decades there has been more research, ink spilled and keystrokes expended on the subject than you can imagine. It’s also important to understand that these two areas of dificulty aren’t binary, though the latter isn more developmentally primitive than the former. There are continua of difficulties in each area (as you recognize) and interacting features of both can be present in a given indivicual. It’s also helpful to remember that these are conceptual models rather than descriptions of material reality. They prepare a clinician with ways to think about what we’re seeing in patients, but rarely conform perfectly to everything we see in a given individual.

Marsha Linehan’s dialectal-behavior therapy (early development in the 1980s) is one but not the only example of a therapy developed for treatment of borderline personality organization. Linehand incorporates cognitive-behavioral treatment methods as well-as techniques with roots in Budhist meditation. She’s not the only researcher/writer on treatments that move beyond traditional Freudian technique (which didn’t work with borderline conditions), but she is perhaps the most widely known at this point. I think you’d hard pressed to find a psychotherapist who isn’t well-acquainted with Linehan’s work, though there are other approaches.

Thanks for chiming, Dr. X. If I remember Simon’s argument right (I’ve returned the book to the library), he claims that he came to his conclusions in the 1980s, started publicizing them in the late 1990s, and only now (ca. 2011, when the book was published) clinicians are coming around to recognizing that his conclusions are right. I don’t remember how much he credits the types of developments you discuss in your comment. I don’t *think* he claims to have thought this all up himself.

And I don’t remember him referencing Liinehan, either. That’s probably something I would have noticed if he had because I had heard of Linehan and DBT. (I’m not sure I’ve actually read her book(s), but I might have checked one out at one point and thought about skimming it.)

One thing that’s frustrating for me is that I don’t know the literature well enough to know what’s been done. Simon does come across (to me) as a moralizer, as Murali suggested above.

Interesting. Without practitioner surveys, I suppose none of us can say when the profession(s) as a whole came around. What I can say is that by the 1970s, psychoanalysts started coming around to the idea of modified approaches to treatment. Previously, patients with serious character disorders were considered un-analyzable and, at best, unresponsive to interpretation of symptoms, defenses and underlying conflicts.

In Chicago, Heinz Kohut first began to write about new ways to understand etiology and treatment of pre-neurotic conditions, especially narcissism. Others (e.g. Otto Kernberg in NY) were simultaneously developing new theories of etiology and approaches to treatment, and lively debates about theory and treatment approach were a regular part of the discussion in academic circles and in training settings.

Kohut and Kernberg’s approaches weren’t behavioral, but they marked a significant shift away from traditional interpretation as intervention. By the late 80s, when I was in training, distinguishing pre-neurotic patients and modified treatment paradigms, including behavioral methods, were certainly the local norm.

I hadn’t heard of Simon until reading your post, so I had to look him up. I see that he’s age 69 so, given when he probably trained at Texas Tech, his training may not have prepared him at all to deal with character disorders (especially what has come to be known as Cluster B). I also see that he’s based in Arkansas. Perhaps perceptions of what is going on in the field varies by locale. Big Northern cities with many academic institutions and major analytic training programs may have fostered local clinical cultures that were more current with developments, though I’d be careful about assuming too much even in that regard because I remember meeting many people who had come from all parts of the country at conferences in Chicago and NY.

Thanks for relating the history of the field. Simon does mention having gone to and presented at conferences, although he doesn’t say which ones or where they were. I should also say that I think he has a bibliography at the end of his book (I forget…but I seem to recall a list of some sort), so that might give some clues into his intellectual influences.

I should also say that his writing seems to have a religious slant. I don’t say that to discredit him, especially because he seems to go out of his way to be as inclusive of non-theists as possible. But it’s probably important to note that that influence seems to work in the background.

One question I’d have is about the intellectual history of his lay audiences. I assume laypersons lag in their understanding and knowledge of such issues. Or if “lag” is the wrong word, they may adopt folk traditions or other traditions into which Simon is inserting himself. His notion of “neurosis” seems directed at popular cultural notions (as much as, or more than, professional notions) of what underlies a lot of “disturbed character” behavior.

Again, thanks for the summary of the past 40 years or so of investigation into these issues.

Prevailing theory assumes that people enforce norms in order to pressure others to act in ways that they approve. Yet there are numerous examples of “unpopular norms” in which people compel each other to do things that they privately disapprove. While peer sanctioning suggests a ready explanation for why people conform to unpopular norms, it is harder to understand why they would enforce a norm they privately oppose. The authors argue that people enforce unpopular norms to show that they have complied out of genuine conviction and not because of social pressure. They use laboratory experiments to demonstrate this “false enforcement” in the context of a wine tasting and an academic text evaluation. Both studies find that participants who conformed to a norm due to social pressure then falsely enforced the norm by publicly criticizing a lone deviant. A third study shows that enforcement of a norm effectively signals the enforcer’s genuine support for the norm. These results
demonstrate the potential for a vicious cycle in which perceived pressures to conform to and falsely enforce an unpopular norm re-inforce one another.

Several recent studies have investigated the consequences of racial intermarriage for marital stability. None of these studies properly control for first-order racial differences in divorce risk, therefore failing to appropriately identify the effect of intermarriage. Our article builds on an earlier generation of studies to develop a model that appropriately identifies the consequences of crossing racial boundaries in matrimony. We analyze the 1995 and 2002 National Survey of Family Growth using a parametr

If there is one thing in that statement which I would take issue with, it is Mallon’s overly optimistic belief that the new policy is “well-meaning”.

That’s because anyone who has spent any time in an Irish hospital over the last few years will have seen the smoking ban enforced in draconian and nasty ways which are simply punitive and judgmental.

Even those who have been fortunate enough to stay away from hospitals in that time can see the results of such bans.

Drive by the Mater on any rainy day, for instance, and you will see patients huddled together in their dressing gowns, exposed to the elements as they take a break from the drudgery of hospital life. This, apparently, is healthier than allowing the patients an enclosed area – which they used to have – where they could smoke without bothering anyone else and, perhaps, not get soaked to the bone at the same time.

People smoke in hospitals for a variety of reasons, and one which is never considered by the authorities is that it is actually good for their head.

Certainly, when my father spent a few years in and out of James’s hospital with the terminal, non-smoking related disease which would ultimately kill him, he measured the days by increments of when he’d go out for a smoke. It broke the endless monotony of living on a ward and, like many other long-term patients, he was determined to not become a ‘lifer’, one of those lost, institutionalised souls who simply lie in bed all day staring at the ceiling.

One might be forgiven for believing that this is more about sin and repentance than concern for the welfare of the sinners.

Queenland

Greetings from Stonebridge a fictitious city in a fictitious state located in a tri-state area in the interior Mid-Atlantic region. We're in western Queenland, which is really a state unto itself, and not to be confused with Queensland in Australia.

Nothing written on this site should be taken as strictly true, though if the author were making it all up rest assured the main character and his life would be a lot less unremarkable.